Provider Demographics
NPI:1528035466
Name:GAILITIS, RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:GAILITIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 COLONIAL DRIVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5682
Mailing Address - Country:US
Mailing Address - Phone:954-977-8770
Mailing Address - Fax:954-977-8774
Practice Address - Street 1:5800 COLONIAL DRIVE
Practice Address - Street 2:SUITE #100
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5682
Practice Address - Country:US
Practice Address - Phone:954-977-8770
Practice Address - Fax:954-977-8774
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060517207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058303100Medicaid
FL12909AMedicare ID - Type Unspecified
FLE19960Medicare UPIN
FL12909AMedicare PIN